Provider Demographics
NPI:1700247319
Name:LIZ'S MASSAGE STUDIO LLC
Entity Type:Organization
Organization Name:LIZ'S MASSAGE STUDIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GLISCZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-686-8682
Mailing Address - Street 1:327 13TH ST S
Mailing Address - Street 2:SUITE # 110
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-4630
Mailing Address - Country:US
Mailing Address - Phone:952-686-8628
Mailing Address - Fax:763-972-3734
Practice Address - Street 1:327 13TH ST S
Practice Address - Street 2:SUITE # 110
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-4630
Practice Address - Country:US
Practice Address - Phone:952-686-8628
Practice Address - Fax:763-972-3734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty